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In the last issue of DIVISION/Review, several active members gave their comments on the Division Practice Survey conducted by Steve Axelrod. The results of the survey showed that our average member has a very limited psychoanalytic practice. The mean number of individual patients seen is about 18 per week almost exclusively on a once per week basis. On average, only 2.8 patients are seen twice per week and 1.3 for three or more weekly therapeutic hours. While most respondents to the survey valued their analytic training, they do little analysis or even analytic therapy.
The very small number of patients seen more than once per week is clearly a major source of concern for the participants in the roundtable discussion, and they proposed a variety of factors that may be at play, all of them undoubtedly important in the shrinking of analytic practice to an almost nonexistent level among our members. Suggested reasons included: a clash of generations, our failure to recognize the importance of culture, derisive and unfounded attacks on analytic therapy from undergraduate professors, insurance cutbacks, myths about psychoanalytic therapy as lacking in evidential basis, and the belief that we practice an outmoded and ineffective form of therapy. These prejudices affect not only potential patients, but also young people interested in pursuing clinical careers. Students hear at both the undergraduate and graduate levels that psychoanalytic therapy is a relic of the past that has been found to be expensive and lacking in beneficial results. There can be no question that analysis and analytic therapy have lost status and no longer appear to be a viable way to make a living to many young clinicians.
These reasons are all undoubtedly contributing to the deterioration of analytic practice, but I wonder if we cannot take the discussion to a different level by asking why these factors are so powerful. For example, we might wonder why even clinically active undergraduate and graduate